Epidemiological investigation of an outbreak of typhoid fever in Jorhat town of Assam, India

BACKGROUND & OBJECTIVES

Typhoid fever is a global health problem and is also endemic in India. An outbreak of fever occurred in January 2014 in Jorhat Town in Assam, India. Here we report the results of an investigation done to find out the aetiology and source of the outbreak.

METHODS

The affected areas were visited on January 23, 2014 by a team of Jorhat district Integrated Disease Surveillance Project personnel. A total of 13 blood samples from patients with fever as first symptom and six water samples were collected from the affected areas. The blood samples were cultured and isolates were identified using standard biochemical tests. Isolates were also tested for antimicrobial sensitivity. Widal test was performed on 10 of the 13 blood samples collected. Sanitary survey was carried out to find any leakage in the water supply and also the sewage system of the Jorhat town.

RESULTS

Blood culture yielded Salmonella enterica serovar Typhi in six (46.15%) patients whereas Widal test was positive in 10 (76.9%) of 13 patients. Water culture showed presumptive coliform count of >180/100 ml in two out of the six samples tested. Salmonella Typhi was also isolated from water culture of these two samples. Sanitary survey carried out in the affected places showed that the water supply pipes of urban water supply were in close proximity to the sewage drainage system and there were few leakages.

INTERPRETATION & CONCLUSIONS

The outbreak occurred due to S. Typhi contaminating the water supply. Sanitation and immunization are the two most important components to be stressed to prevent such outbreaks.

Helicobacter pylori infection and risk of salmonella infection

Helicobacter pylori (H pylori) infection is the most frequent infection worldwide and it has been postulated that it predisposes to multiple enteric pathogens and diarrheal diseases. Salmonella infection is common in tropical and under developed communities and is associated with wide range of diseases from gastroenteritis to typhoid fever. This study aimed at detecting the impact of H pylori infection on the incidence of salmonella infections.The study participants were sampled from cohorts of patients in four university hospitals in different Egyptian Governorates. Their age ranged from 20 to 59 years and followed up for a rising Widal test. Case patients (n = 109) were subjects who visited the outpatient clinic because of diarrhea and typhoid like illness. They were either positive for H pylori stool antigen (n = 53) or negative to it (n = 56). All patients were subjected to thorough history taking, clinical examination, routine laboratory investigations, abdominal ultrasonography, H pylori stool antigen detection, and serial Widal test assay.The proportion of salmonella-infected subjects was lower among case patients with H pylori infection (22.6%) than among those negative for H pylori (33.9%) albeit not statistically significant (adjusted odds ratio [OR], 0.57; 95% confidence interval [CI], 0.24-1.33; P = .21). The association persisted nonsignificant after adjusting for sociodemographic variables (adjusted OR, 0.5; 95% CI, 0.18-1.39; P = .18). In a multivariate analysis that adjusted for sex, dietary habits, socioeconomic status, and educational level subjects who eat outdoors were associated with a significantly greater risk of salmonella typhi infection.Our findings suggest that there is no association between H pylori infection and salmonella infection in patients presented with typhoid fever or typhoid like illness.

Clinical Presentations, Treatments, and Complications of Ileal Perforation at a Tertiary Center: A Cross-Sectional Study

Background Ileal perforations represent one of the most common surgical emergencies in India, associated with significant morbidity and mortality rates. The causes of these perforations include infections such as tuberculosis and enteric fever, as well as malignancy and trauma. Management options encompass ileostomy, resection with anastomosis, and primary closure. Objective The objective of this study is to evaluate the clinical profile, etiology, management strategies, and complications associated with ileal perforation. Methodology A total of 70 patients with ileal perforation were included in the study. The proportions of various etiological factors, surgical interventions, and their associated complications were analyzed. The study aimed to determine whether ileostomy leads to fewer complications compared to primary repair. Results Ileal perforation is more prevalent in males than in females, with an incidence ratio of 2.68:1, predominantly affecting individuals in their 30s. Antituberculosis treatment does not consistently protect against perforation. Delays in presentation are linked to a higher likelihood of developing pyoperitoneum, increased chances of stoma creation (with a mean delay of 2.50 days in the closure group compared to 4.98 days in the ileostomy group), and greater mortality. Closure was performed in 18 patients (25.7%), while 52 patients (74.3%) underwent stoma creation. The duration of surgery was longer in the closure group (2.889 hours) than in the ileostomy group (2.635 hours) and also greater in the mortality group (three hours) compared to the non-mortality group (2.64 hours). The mean number of perforations was 1.59 ± 0.970, with 1.33 ± 0.840 in the closure group and 1.67 ± 1.004 in the ileostomy group. A higher number of perforations is associated with an increased likelihood of stoma creation. The most common cause of perforation was nonspecific, accounting for 40% of cases. The most frequently encountered complication was wound infection, occurring in 42.9% of patients. The mean duration of hospital stay was shorter in the ileostomy group (9.50 ± 5.500 days) than in the closure group (17.22 ± 19.219 days). Death occurred in 18.6% of cases, with higher rates observed in males (8:5), patients with delayed presentation, and elderly patients. A significant p-value was found in relation to leaks and fecal fistulas. Conclusions No significant difference was observed in complications associated with the various surgical procedures performed. However, a delay in presentation is linked to a higher rate of complications and increased mortality.

Traditional Widal Agglutination Test Versus Rapid Immunochromatographic Test in the Diagnosis of Enteric Fever: A Prospective Study From South India

Introduction Early diagnosis and treatment are crucial to reducing the morbidity of patients with enteric fever/typhoid fever. Among the available diagnostic tests, the blood culture is considered a gold standard. However, in most of the developing and resource-limited settings, the diagnosis is made utilizing the traditional Widal test and rapid immunochromatographic test (ICT). This study was aimed to compare the diagnostic value and efficacy of ICT and traditional Widal test in the diagnosis of typhoid fever. Methods A prospective study was conducted, and 40 patients were included in the study. The Widal test and Salmonella enterica serovar Typhi IgM/IgG immunochromatographic test were performed for all the patients. The Widal is a tube agglutination test, and the rapid ICT utilizes the principle of enzyme-linked immunosorbent assay (ELISA). All the samples were also tested for the presence of antibodies (IgG and IgM) against the S. enterica serovar Typhi and the titers against 'O' and 'H' antigens of S. enterica serovar Typhi. An antibody titer of 1:80 or more against the 'O' and 'H' antigen was considered positive. Results In the ICT, 24 samples (60%) tested positive for the IgM antibodies, and only 15 samples tested positive and for IgG antibodies. In the Widal test, 27 samples (67.6%) returned positive for antibodies against the S. enterica serovar Typhi 'O' antigen. The sensitivity (90% vs 72.73%), specificity (81.25% vs 64%), and accuracy (82.12% vs 64.87%) for the Widal test were found to be more when compared to the ICT. Conclusion The results indicate that the traditional Widal agglutination test is superior to the rapid ICT in the diagnosis of enteric fever. However, both these tests cannot be considered as gold standards for the diagnosis owing to their low positive predictive values.